Posts filed under ‘Desinfection and Sterilization’

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

Morbidity and Mortality Weekly Report (MMWR) (CDC) January 10, 2020 V.69 N.1 P-6-9

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1). Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1). C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2). As of June 28, 2019, a total of 801 patients with…..

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm?s_cid=mm6901a2_w&deliveryName=USCDC_921-DM16734

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 9, 2020 at 3:22 pm

Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients.

Journal of Bone and Joint Infection September 18, 2019 V.4 N.5 P.209-215.   

Abad CL1, Phuoc V2, Kapoor P3, Tosh PK4, Sia IG4, Osmon DR4, Tande AJ4.

Author information

1 Department of Internal Medicine, Section of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

2 Division of Hematology, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

3 Division of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

4 Mayo Clinic, Rochester MN, USA.

Abstract

Background:

Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.

Methods:

We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.

Results:

Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).

Conclusion:

BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831805/pdf/jbjiv04p0209.pdf

December 27, 2019 at 3:55 pm

Prosthetic Joint Infection due to Actinomyces species: A case series and review of literature.

Journal of Bone and Joint Infection August 2, 2019 V.4 N.4 P.174-180.

Dagher R1, Riaz T1, Tande AJ1, Osmon DR1, Jagtiani A1, Steckelberg JM1, Mabry T2, Berbari EF1.

Author information

1 Department of Internal Medicine and Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905.

Abstract

Background:

Actinomyces prosthetic joint infections (APJIs) are rare and optimal medical and surgical treatment strategies are unknown. The purpose of our study was to characterize the demographics, risk factors, management and outcomes of patients with PJIs due to Actinomyces spp.

Methods:

Using a retrospective cohort study design, the medical records of all patients with Actinomyces spp. total hip or knee arthroplasty infection (APJI) seen at a single institution between January 1, 1969 and December 31, 2016 were reviewed. We abstracted information including patient demographics, co-morbidities, joint age, surgical history, microbiology, management and outcomes. A simultaneous literature search via PubMed was performed to identify cases of APJI published in literature and a descriptive analysis was performed.

Results:

Eleven cases were identified over a 47 year study period at our institution. Seven patients (64%) were female. The median age at the time of diagnosis of infection was 71 years (range, 57-89). The knee was involved in six cases (55%) followed by the hip in 5 (45 %) cases. Three cases had dentures, broken teeth, or poor dentition. Actinomyces odonotlyticus was the most commonly found subspecies at our institution. Median ESR and CRP values were 61mm/hr and 64 mg/L respectively. Eight (72%) patients were managed with 2 stage exchange. Most patients received a course of beta-lactam therapy for 6 weeks. Ten cases (91%) were free of failure after a median duration of follow-up of 2 years (range, 0.67 – 5 years). The median duration from joint arthroplasty to the onset of symptoms was 162 days, range (20-3318). Six (54%) had a history of prior PJI with a different microorganism at the same joint site and 4 patients had history of prior 2 stage exchange (36%). In the literature group, we identified 12 cases and the most common subspecies was Actinomyces israelii; most patients underwent two stage exchange and were treated with 6 weeks of beta lactam antibiotics.

Conclusions:

Based on our observational study, Actinomyces PJI presents as a late complication of TJR, may be associated with prior PJI at the index joint and antecedent dental manipulation may portend as an additional risk factor. Treatment includes two stage exchange and beta- lactam therapy for 6weeks. These results will help clinicians in improved understanding and management of APJIs which although are rare but warrant special attention as population with implanted joint arthroplasties continues to rise.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757008/pdf/jbjiv04p0174.pdf

 

December 27, 2019 at 3:52 pm

Pseudomonas Prosthetic Joint Infections: A Review of 102 Episodes.

Journal of Bone and Joint Infection June 4, 2016 V.1 P.25-30.

Shah NB1, Osmon DR1, Steckelberg JM1, Sierra RJ2, Walker RC1, Tande AJ1, Berbari EF1.

Author information

1 Department of Internal Medicine and Division of Infectious Disease, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.

Abstract

Background: The outcome of patients with Pseudomonas prosthetic joint infection (PS PJI) has not been well studied. The aim of this retrospective cohort study was to assess the outcome of patients with Pseudomonas PJI and to review risk factors associated with failure of therapy. Methods: Between 1/1969 and 12/2012, 102 episodes of PS PJI in 91 patients were identified. Results: The mean age at the time of diagnosis was 67.4 years; forty three percent had knee involvement. Over 40 percent had either diabetes mellitus or a history of gastrointestinal or genitourinary surgery. Nearly half (48 out of 102 episodes) received aminoglycoside monotherapy, while 25% received an anti-pseudomonal cephalosporin. The 2-year cumulative survival free from failure was 69% (95% CI, 56%-82%). Patients treated with resection arthroplasty, two-stage exchange, and debridement with implant retention had a 2-year cumulative survival free from failure of 80% (95% CI, 66%-95%), 83% (95% CI, 60%-100%), and 26% (95% CI, 23%-29%) respectively (P=0.0001). Conclusions: PS PJI’s are associated with a high failure rate. Patients treated with debridement and implant retention had a worse outcome.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423557/pdf/jbjiv01p0025.pdf

December 27, 2019 at 3:48 pm

APSIC GUIDELINES for the prevention of SSI.  

Antimicrob Resist Infect Control. November 12, 2019 V.8 P.174.

Ling ML, Apisarnthanarak A, Abbas A, et al.

Background

The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices.

Method

The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section.

Results

It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions.

Conclusions

Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852795/pdf/13756_2019_Article_638.pdf

December 13, 2019 at 7:15 am

2019-11 Hospital-Acquired Infections in New York State, 2018 –  N York State Department of Health 24 Pags

Contents

Introduction ………………………………………………………………………………………………………… 3

Surgical Site Infections (SSIs)………………………………………………………………………………………………. 4

Catheter-Associated Infections ………………………………………………………………………………………………………… 5

Laboratory-identified (LabID) infections………………………………………………………………………………………. 6

Clostridioides difficile Infections (CDI)……………………………………………………………………………………………….. 7

Carbapenem-resistant Enterobacteriaceae (CRE) Infections………………………………………………………………………………………. 8

Methicillin-resistant Staphylococcus aureus (MRSA) Infections………………………………………………………………………………………. 9

Hospital Performance …………………………………………………………………………………………………………10

Role of the State Health Department…………………………………………………………………………………….23

What Patients Can do to Prevent Infections………………………………………………………………………………………..24

PDF

https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2018/docs/hospital_acquired_infection_p1.pdf

November 20, 2019 at 7:11 am

Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit

Emerging Infectious Diseases October 2019 V.25 N.10

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of blaoxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/25/10/18-1626_article?deliveryName=DM9244

PDF (CLIC en DOWNLOADS / ARTICLE)

September 23, 2019 at 10:00 am

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